Mapping nursing practices in rehabilitation units in Spain and the United Kingdom: A multiple case study.

Because of the crisis in the health sector with few employment opportunities, many Spanish nurses are looking for professional development abroad. No studies have mapped nursing practices across Europe. The aim of this research was to provide a comprehensive approach to understand nursing practices and features of the context in Spain and the United Kingdom within the rehabilitation unit and to discuss those practices from a patient safety point of view. Multiple case study design with thematic analysis was applied in this study. The methods for data collection were in-depth interviews, nonparticipant observations, and document analysis. Results were classified into six categories: resources, techniques and nursing procedures, patients' personal care, health education, documentation task, and attitudes and communication skills. This study concludes that differences exist between nursing practices despite both countries having similar nursing competences. In addition, the UK unit has a positive safety culture, recognizes that mistakes happen, and applies more barriers to avoid them. The study provides valuable information to help the decision-making process for Spanish nurses considering working in the UK.

Specialized nursing terminology for the care of people with spinal cord injury / Terminología especializada de enfermería para el cuidado a la persona con lesión medular / Terminologia especializada de enfermagem para o cuidado à pessoa com lesão medular

ABSTRACT Objective: To develop a bank of terms of specialized nursing language based on the International Classification for Nursing Practice (ICNP®) for the care of the person with spinal cord injury. Method: Descriptive, quantitative study guided by the guidelines of terminological studies. Terms were extracted from an official document of the Ministry of Health through use of a computer tool, and were standardized and mapped with the ICNP® Version 2015. Results: We identified 446 relevant terms, of which 265 were equal, 68 were similar, 23 were more comprehensive, 66 were more restricted, and 24 were not in concordance with terms of the ICNP®. Terms classified as equal and similar were considered as constant. Thus, the bank of terms consisted of 333 constant terms and 113 not contained in the classification. Terms included in the Focus, Action, Means and Location axes predominated. Conclusion: The bank of terms will contribute to the construction of the ICNP® terminology subset for the care of people with spinal cord injury.

RESUMEN Objetivo: Elaborar un banco de datos de términos del lenguaje, con base en la Clasificación Internacional para la Práctica de Enfermería (CIPE®), para el cuidado a la persona con lesión medular. Método: Investigación descriptiva, de abordaje cuantitativo, orientada por las directrices de estudios terminológicos. Los términos fueron extraídos de documento oficial del Ministerio de la Salud, mediante uso de herramienta computacional, normalizados y mapeados con la CIPE® Versión 2015. Resultados: Se identificaron 446 términos relevantes, siendo 265 iguales, 68 similares, 23 más amplios, 66 más restrictos y 24 sin concordancia con los términos de aquella clasificación. Los términos clasificados como iguales y similares se consideraron constantes. De ese modo, el banco de términos estuvo constituido de 333 términos constantes y 113 no constantes en la clasificación. Predominaron términos clasificados en los ejes Foco, Acción, Medios y Ubicación. Conclusión: El banco de términos contribuirá a la construcción de un subconjunto terminológico CIPE® para el cuidado a personas con lesión medular.

RESUMO Objetivo: Elaborar um banco de termos da linguagem especializada de enfermagem, com base na Classificação Internacional para a Prática de Enfermagem (CIPE®), para o cuidado à pessoa com lesão medular. Método: Pesquisa descritiva, de abordagem quantitativa, orientada pelas diretrizes de estudos terminológicos. Os termos foram extraídos de documento oficial do Ministério da Saúde, mediante uso de ferramenta computacional, normalizados e mapeados com a CIPE® Versão 2015. Resultados: Identificaram-se 446 termos relevantes, sendo 265 iguais, 68 similares, 23 mais abrangentes, 66 mais restritos e 24 sem concordância com os termos daquela classificação. Os termos classificados como iguais e similares foram considerados constantes. Assim, o banco de termos foi constituído por 333 termos constantes e 113 não constantes na classificação. Predominaram termos classificados nos eixos Foco, Ação, Meios e Localização. Conclusão: O banco de termos contribuirá para a construção de um subconjunto terminológico CIPE® para o cuidado de pessoas com lesão medular.

Catálogo CIPE® para pacientes adultos em processo de neurorreabilitação / ICNP® catalog for adult patients in Neurorehabilitation process

Introdução: A neurorreabilitação é identificada, como um importante componente no processo saúde-doença de pessoas com deficiência, condição cada vez mais complexa e diversificada. O Processo de Enfermagem é uma ferramenta metodológica que deve ser utilizada para direcionar os cuidados prestados a essa população e para utilizá-la é recomendado o uso de uma terminologia unificada, capaz de possibilitar, aos enfermeiros codificar, armazenar e recuperar a informação em um formato que possa ser útil e aplicável na assistência ao paciente. Objetivo: construir um Catálogo de conceitos da Classificação Internacional para a Prática de Enfermagem (CIPE®) na neurorreabilitação de adultos. Método: Trata-se de um estudo metodológico desenvolvido em quatro etapas: composição dos enunciados de diagnósticos / resultados e intervenções de enfermagem; construção de definições operacionais para os enunciados dos diagnósticos / resultados de enfermagem; validação de conteúdo dos enunciados e das definições operacionais dos diagnósticos/resultados de enfermagem e dos enunciados das intervenções de enfermagem junto a enfermeiros especialistas na área; organização do Catálogo de acordo com o Modelo de Adaptação de Roy. Resultados: Foram construídos 1490 enunciados, sendo 394 diagnósticos/resultados de enfermagem e 1090 intervenções de enfermagem. Validou-se quanto ao conteúdo 266 diagnósticos/resultados de enfermagem e 540 intervenções. Os enunciados foram alocados nos modos do Modelo de Adaptação de Roy, sendo 20 diagnósticos/resultados e as intervenções de enfermagem no modo desempenho de papel, 10 diagnósticos/resultados e suas intervenções de enfermagem no modo interdependência; 52 no modo autoconceito e, 184 no modo fisiológico. Conclusão: desenvolveu-se um Catálogo CIPE® para Adultos em processo de neurorreabilitação à luz do modelo teórico de adaptação de Roy. Diagnósticos / resultados e intervenções de enfermagem foram propostos e validados e para ajudar o raciocínio clínico do enfermeiro. Este foi julgado como refletindo as demandas que a população pode apresentar durante o processo de neurorreabilitação e seu uso dará suporte à documentação sistemática do cuidado clínico de enfermagem, usando a CIPE® como terminologia de referência. A CIPE® tem sido considerada uma classificação versátil pois se adapta às muitas realidades e singularidades da prática de enfermagem. Neste sentido, acredita-se que esse Catálogo possa ser usado por enfermeiros reabilitadores na sua prática, padronizando a linguagem empregada e contribuindo com o processo de tomada de decisão clínica.(AU)

Introduction: Neurorehabilitation is identified as an important component in the healthdisease process of people with disabilities, an increasingly complex and diversified condition. The Nursing Process is a methodological tool that should be used to direct the care provided to this population and to use it, it is recommended to use a unified terminology, capable of enabling nurses to code, store and retrieve information in a format which may be useful and applicable in patient care. Objective: to construct a Catalog of concepts of the International Classification for Nursing Practice (CIPE®) in adult neuro-rehabilitation. Method: It is a methodological study developed in four stages: composition of the statements of diagnoses / results and nursing interventions; construction of operational definitions for statements of nursing diagnoses / results; validation of contents of statements and operational definitions of nursing diagnoses / results and statements of nursing interventions with specialist nurses in the area; organization of the Catalog according to Roy's Adaptation Model. Results: A total of 1490 statements were constructed, being 394 nursing diagnoses / results and 1096 nursing interventions. 266 nursing diagnoses / results and 540 interventions were validated. The statements were allocated in the Roy Adaptation Model modes, with 20 diagnoses / results and the nursing interventions in paper performance mode, 10 diagnoses / results and their nursing interventions in the interdependence mode; 52 in the self-concept mode, and 184 in the physiological mode. Conclusions: a CIPE® Catalog for Adults in the process of neurorehabilitation was developed in light of Roy's theoretical model of adaptation. Diagnoses / outcomes and nursing interventions were proposed and validated and should enhance the nurses' clinical reasoning. This was judged as reflecting the demands that the population may present during the neuro-rehabilitation process and its use will support the systematic documentation of clinical nursing care, using CIPE® as a reference terminology. CIPE® has been considered a versatile classification because it adapts to the many realities and singularities of nursing practice. In this sense, it is believed that this Catalog can be used by rehabilitation nurses in their practice, standardizing the language used and contributing to the clinical decision-making process.(AU)

[Therapeutic Nursing in Neurological (Early-)Rehabilitation: A Grounded Theory Study]. / Therapeutische Pflege in der neurologischen (Früh-)Rehabilitation: Eine Grounded-Theory-Studie.

PURPOSE: What is therapeutic nursing? This question is gaining relevance in the context of the billing of services in the DRG system (DRG=Diagnosis-Related Groups), because in paragraph 8-552 of the operations and procedures coding system (OPS), it is explicitly stated that therapeutic care must be carried out by specially trained personnel. To date, empirical results on therapeutic nursing in neurological early rehabilitation are sparse. The objective of the study is to develop a theory of therapeutic care in neurological early rehabilitation. MATERIALS AND METHODS: The study is based on the method of grounded theory. Open participatory observations (n=92) and episodic interviews (n=10) with nursing professionals and nursing auxiliaries were conducted in 5 inpatient rehabilitation clinics. RESULTS: The theory of therapeutic nursing includes 6 categories: (1) nursing care, (2) observation/perception, (3) communication, (4) autonomy and individual needs of patients and their relatives, (5) multi-professional team and (6) prerequisites. DISCUSSION: The results indicate which aspects are included in therapeutic nursing and the necessary prerequisites for delivering therapeutic nursing. Against this background, continuing education programs reveal conspicuous gaps in the area of knowledge transfer and application in practice. CONCLUSIONS: The results of the study should be taken into consideration and integrated in nursing education, both at the basic level and in continuing education.

[Terms of international classification for Nursing Practice in motor and physical rehabilitation]. / Termos da Classificação Internacional para a Prática de Enfermagem em reabilitação físico-motora.

OBJECTIVE: To validate terms of nursing language especially for physical-motor rehabilitation and map them to the terms of ICNP(®) 2.0. METHOD: A methodology research based on document analysis, with collection and analysis of terms from 1,425 records. RESULTS: 825 terms were obtained after the methodological procedure, of which 226 had still not been included in the ICNP(®) 2.0. These terms were distributed as follows: 47 on the Focus axis; 15 on the Judgment axis; 31 on the Action axis; 25 on the Location axis; 102 on the Means axis; three on the Time axis; and three on the Client axis. All non-constant terms in ICNP(®) have been validated by experts, having reached an agreement index ≥0.80. CONCLUSION: The ICNP(®) is applicable and used in nursing care for physical-motor rehabilitation.

Terms of international classification for Nursing Practice in motor and physical rehabilitation / Términos de la Clasificación Internacional para la Práctica de Enfermería en Rehabilitación físico-motora / Termos da Classificação Internacional para a Prática de Enfermagem em reabilitação físico-motora

OBJECTIVE To validate terms of nursing language especially for physical-motor rehabilitation and map them to the terms of ICNP® 2.0. METHOD A methodology research based on document analysis, with collection and analysis of terms from 1,425 records. RESULTS 825 terms were obtained after the methodological procedure, of which 226 had still not been included in the ICNP® 2.0. These terms were distributed as follows: 47 on the Focus axis; 15 on the Judgment axis; 31 on the Action axis; 25 on the Location axis; 102 on the Means axis; three on the Time axis; and three on the Client axis. All non-constant terms in ICNP® have been validated by experts, having reached an agreement index ≥0.80. CONCLUSION The ICNP® is applicable and used in nursing care for physical-motor rehabilitation. .

OBJETIVO Validar los términos del lenguaje especial de enfermería en rehabilitación físico-motora y mapearlos con los términos de la CIPE® 2.0. MÉTODO Investigación metodológica basada en análisis documental, con recolección y análisis de términos de 1.425 fichas. RESULTADOS Después del procedimiento metodológico, fueron obtenidos 825 términos, de los que 226 todavía no figuraban en la CIPE® 2.0 y que fueron distribuidos de la siguiente manera: 47 en el eje foco; 15 en el eje juicio; 31 en el eje acción; 25 en el eje ubicación; 102 en el eje medios; tres en el eje tiempo; y tres en el eje cliente. Todos los términos no obrantes en la CIPE® fueron validados por los expertos, habiendo alcanzado índice de concordancia ≥ 0,80. CONCLUSIÓN La CIPE® es aplicable y utilizada en la asistencia de enfermería en rehabilitación físico-motora. .

OBJETIVO Validar os termos da linguagem especial de enfermagem em reabilitação físico-motora e mapeá-los com os termos da CIPE® 2.0. MÉTODO Pesquisa metodológica baseada em análise documental, com coleta e análise de termos de 1.425 prontuários. RESULTADOS Após o procedimento metodológico, obteve-se 825 termos, dos quais 226 ainda não constavam na CIPE® 2.0 e que foram assim distribuídos: 47 no eixo foco; 15 no eixo julgamento; 31 no eixo ação; 25 no eixo localização; 102 no eixo meios; três no eixo tempo; e três no eixo cliente. Todos os termos não constantes na CIPE® foram validados pelos especialistas, havendo atingido índice de concordância ≥ 0,80. CONCLUSÃO A CIPE® é aplicável e utilizada na assistência de enfermagem em reabilitação físico-motora. .

[Catalogues of therapeutic nursing activities in neurological early rehabilitation]. / Leistungskataloge der aktivierend-therapeutischen Pflege in der neurologischen Frührehabilitation.

Under the German DRG-system, hospital-based rehabilitation of still critically ill patients becomes increasingly important. The code for early neurological rehabilitation in the DRG-system's (Diagnosis Related Groups) list of operations and procedures requires an average daily therapeutic intensity of 300 min, part of which is being contributed by therapeutic nursing. As therapeutic aspects are integrated in other nursing activities, it is difficult to separate its time consumption. This problem is pragmatically resolved by catalogues of therapeutic nursing activities which assign plausible amounts of therapeutic minutes to each activity. The 4 catalogues that are used most often are described and compared. Nursing science has not focused yet on therapeutic nursing.

[The validity of the "Working Group on Nursing in Early Rehabilitation" (AGnFP) catalogue]. / Dokumentation von Leistungen der therapeutisch-aktivierenden Pflege in der neurologisch-neurochirurgischen Frührehabilitationmit Hilfe des Katalogs der niedersächsischen "Arbeitsgemeinschaftneurologische Frührehabilitationspflege" (AGnFP).

INTRODUCTION: Nursing is most important in neurological early rehabilitation to achieve a good outcome. In the present study, the validity of the catalogue of the "Working Group on Nursing in Early Rehabilitation" (AGnFP) has been examined. METHODS: 54 neurological early rehabilitation patients (mean age 68.3 (14.7) years) have been enrolled. All nursing processes (basic and medical care) have been documented through timekeeping. RESULTS: A nursing total of 205.9 (122.6) min/d per patient was found. In the AGnFP-catalogue, 177.5 (130.9) min/d have been documented (86.2% of all nursing processes). Barthel-index correlated negatively with basic nursing care (r = − 0.42, p < 0.01). The early rehabilitation index showed a negative correlation with medical nursing processes (r = − 0.46, p < 0.01). The AGnFP catalogue correlated with basic nursing processes (r = 0.69, p < 0.001). DISCUSSION: The AGnFP-catalogue is a tool to document nursing in early neurological rehabilitation. Further studies are strongly encouraged.

[Therapeutic nursing: a systematic review]. / Therapeutische Pflege und Rehabilitation: Eine systematische Literaturübersicht.

BACKGROUND: For some years therapeutic service catalogues have been established in medical rehabilitation which have broadened our previous understanding of nursing actions. Currently, therapeutic nursing plays a prominent role in neurological early rehabilitation because the operations and procedures coding system (OPS) 8-552 within the DRG-System (Diagnosis Related Groups) states that therapeutic nursing must be carried out by specially trained nursing personnel. This requirement leads to inconsistencies in nursing practice and the medical service of the health insurance (MDK) since a definition of therapeutic nursing is lacking. A previous review of therapeutic nursing in 2003 focused primarily on the development of the therapeutic nursing role, but not on therapeutic nursing itself. The following article contains the first systematic review of the current state of research regarding a definition of therapeutic nursing. For this purpose, a systematic study was conducted to examine if there are, nationally or internationally, any definitions of therapeutic nursing and to identify what the therapeutic aspects of nursing are. METHODS: The research included following database; Medline, Cinahl and Embase. Additionally, a research by hand of several German journals as well as textbooks and specialized literature was carried out. RESULTS: 5 studies were selected which define the term "therapeutic nursing". Among these are one review, one primary study, one theoretical discussion and one dissertation. Further twenty four studies were identified which do not define the term, but are closely related to the subject, and use or characterize the term in various contexts. CONCLUSIONS: The publications examined provided indications of duties, interventions and roles nurses should perform, but not how to carry these out, nor what is therapeutic about the nursing. At the same time, the low number of studies reveals that therapeutic nursing has barely been examined and demonstrates the lack of theoretically grounding through nursing science.

Tradução e adaptação transcultural do instrumento Edmonton Symptom Assessment System para uso em cuidados paliativos / Translation and cultural adaptation of the instrument Edmonton Symptom Assessment System for use in palliative care

O objetivo deste estudo foi realizar a tradução e adaptação transcultural, para o português do Brasil, do instrumento Edmonton Symptom Assessment System (ESAS-r) para uso em Cuidados Paliativos. A ESAS-r é uma versão revisada do instrumento ESAS e foi desenvolvida no Canadá por pesquisadoras que estudam a temática dos Cuidados Paliativos. A ESAS-r consiste de uma escala visual numérica, com gradação de zero a 10, para avaliar nove sintomas (pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, shortness of breath, wellbeing) e um sintoma adicional considerado relevante para o paciente. Utilizou-se o referencial metodológico de Beaton et al (2000) para realização do estudo, composto de seis etapas: tradução, realizada por dois tradutores independentes; síntese das duas traduções; retrotradução, por outros dois tradutores; revisão por comitê de especialistas, com a intenção de avaliar as equivalências semântica, idiomática, experimental e conceitual; pré-teste, composto por 30 participantes, sendo eles 10 pacientes, 10 familiares e 10 enfermeiras; e submissão da versão traduzida aos autores do instrumento original. Como resultado foram realizadas algumas alterações no título, enunciado e em determinados termos do instrumento para adequação da gramática e vocabulário brasileiros. De forma geral, a maioria dos participantes entendeu o significado das palavras referidas na versão traduzida da ESAS-r. Houve somente uma dúvida com relação ao termo náusea. Foi sugerida a inserção de uma explicação sobre o significado da palavra náusea, assim como recomendada a padronização do termo Sem na coluna à esquerda do instrumento e a substituição da palavra depressão por tristeza. Esta Escala poderá ser utilizada tanto por pacientes, quanto por familiares e profissionais da saúde. Entretanto, para que isso ocorra, é necessária a validação do instrumento com a verificação das propriedades psicométricas.